Purpose of the study: The incidence and type of complications observed with arthroscopic procedures remains a timely subject, particularly as the use of new techniques becomes increasingly widespread.

Material and methods: In cooperation with the members of ISAKOS, The International Society of Arthroscopy, Knee surgery and Orthopaedic Surgery, we instituted two studies: a retrospective study of upper limb arthroscopy complications and a prospective incidence study during a 30-day inclusion period with patient review at one month and quality-of-life scoring.

Results: The retrospective study analyzed complications of 57,604 arthroscopic procedures of the upper limb performed by 99 surgeons from 38 countries. Neurological complications, though generally transient, were the most frequent and were related to traction, locoregional anesthesia or the operative technique. Four deaths were recorded, all anesthesia-related. The prospective study included 364 patients operated on by 50 surgeons. There were 16 initial complications (4.39%): material problem (n=12), three intraoperative bleeding (n=3), atelectasia (n=1). The rate of conversion was 2.47%. At one month, there were five complications reported in 133 patients (3.75%): anesthesia-related problem (n=1), bleeding (n=1), synovial fistula (n=1), reflex dystrophy (n=2). There were no infections and no neurological lesions. The one-month outcome was considered good or excellent by 98.5% of surgeons.

Discussion and conclusion: The results of these surveys are in agreement with data in the literature where the rate of complications is higher in prospective studies than in retrospective studies. The prospective study did not disclose any neurological complication while arthroscopy of the upper limb is generally considered to raise the risk of with this type of complication. This study recalls that although arthoscopy has enabled a decreased incidence in complications compared with open surgery, it is not a benign intervention and can produce complications.

Introduction: The emergence of multidrug resistant Gram negative bacilli susceptible to hardly any beta lactam compound has led to infections close to a therapeutic dead end. In such circumstances, Imipenem-cilastatin (I-C) is often the only remaining therapeutic option. We report our experience with the prolonged administration of high-doses of I-C in the treatment of osteoarticular infections with bacteria resistant to other beta-lactam agents (or 4^l generation cephalosporins in 14 cases).

Materials and methods: Our retrospective study over 7 years included 29 patients with septic arthritis (n=3) continuous osteitis (n=6), septic non-union(n=12) and prosthetic joint infections (n=8). Treatment included an extensive surgical debridement and post-operative combination antibiotherapy with intravenous I-C and aminoside (54%) and/or fluoroquinolones (46%) and/or fosfomycin (29%). Associated microorganisms requiring yet additional antimicrobial agents were associated in 17 (59%) cases. I-C was maintained for an average of 46 days (extremes 21–90), at an average dose of 3,8g/day (extremes 2–6). The bacteria warranting I-C were cephalosporinase hyperproducing Enterobacter cloacae (38%), extended spectrum beta-lactamases producing enterobacteria (31%), Pseudomonas aeruginosa (21%) and/or Acinetobacter baumanii (21%).

Results: Early outcome was favorable in 24 patients (82%). Two patients relapsed with the bacteria requiring I-C. Three failed to negate succion fluid cultures : one was discharged with no change in his condition, one agreed to a leg amputation and the third died of candidemic septic shock in SICU with drainage fluid still bactériologie ally positive. Repeated secondary colonization and systemic infection with yeasts led to a monitoring of yeast load. Per os amphotencin B and immediate treatment of urinary colonization prevented further systemic dissemination of candical infections. No other tolerance incidents were noted. Acquired resistance occurred only once in a P. aeruginosa isolate while Imipenem-cilastatin was chosen to cover an ESBL producing Escherichia coli. Secondary treatment with ceftazidime was then successful in eradicating P. aeruginosa.

Conclusion: I-C has been widely used for the treatment of mixed flora infections as a wide spectrum antibiotic.

We report good tolerance of high posology long term administration in documented osteoarticular indications if yeast colonization is properly monitored, and eradication rates are comparable to those reported in infections with susceptible bacteria.

Purpose: The purpose of our work was to study the effects of sequential arthroscopic section of the anterior capsule of the shoulder joint using an experimental model of retractile capsulitis induced by heat treatment.

Material and methods: Twelve cadaver shoulders were studied. Passive mobility was initially normal. Anterior capsule retraction was first created under arthroscopic control (Arthrocare® generator, power 2). Twelve programmed sequential sections were then performed successively using the thermal probe (Arthrocare®, power 9) on: the coracohumeral ligament (CHL) and the superior glenohumeral ligament (SGHL), the middle gleno-humeral ligament (MGHL), the inferior glenohumeral ligament (IGHL), and the intra-articular portion of the subscapular muscle tendon (SST). The posterior capsule was not studied. At each step, motion was measured independently by two operators. At the end of the sequence, the articulation was opened to verify the sections as was the absence of any injury to noble structures.

Results: Measures were reproducible (mean difference 5° between two series). The sections were correctly achieved. Macroscopically, there were no injuries to noble structures. The role of the different elements studied were as follows: — rotator interval (CHL, SGHL): gain in RE1 (mean 40°) and RE2 (mean 35°) (greater than loss during retraaction; — IGHL: gain in elevation (mean 33°); — IGHL and rotator interval: potentialisation of gain in FE2 (mean 41°) and elevation (mean 50°); — MGHL: moderate increase in external rotation at 45° antepulsion and elevation (mean 20°); —SST: discrete gain in RE1 (10°) but risk of dislocation (n=1).

Discussion: Our model was reproducible. Section of the anterior capsule by a thermal method did not produce macroscopic injury to neighboring tissues. Our study pointed out the preeminent importance of sectioning the rotator interval for recovering external rotation. This section, combined with section of the IGHL has a potentialsing effect. The limitation of our study is the absence of examination of the posterior capsule.

Purpose: The risk of recurrence would be greater after arthroscopic treatment of shoulder instability compared with open repair. We wanted to find what effect bone lesions and more particularly posterosuperior notch in the humerus have on outcome after arthroscopic management of shoulder instability.

Material and methods: We made a retrospective analysis of 60 patients who underwent an arthroscopic procedure between February 1993 and December 1998. Mean age was 28 years three months. All patients in this series had a bony notch measured on the preoperative scan. Six measurements were made to determine the volume of the notch approximated to the half volume of a revolution ellipse. The ratio of this volume to total volume of the humeral head (approximated as a sphere) was also calculated. The glenoid cavities were classed in four groups: normal, abrasion, fracture, amputation. Operative result was assessed with the Duplay score at a mean follow-up of 42.7 months.

Results: Outcome was excellent in 24 patients, good in 14, fair in seven, poor in five including four related to recurrent instability, and a failure in ten requiring reoperation. The rate of recurrence with reoperation was 16.6%. Notch volumes varied from 0 to 4792 mm³ (mean 1019±1253). The notch/ head ratio ranged from 0 to 10.5% (mean = 2.28±2.63). Only 12 patients (20%) did not have a bony notch; 11 of them had an excellent or good result. Mean volume of the notch in patients with excellent, good, or fair outcome (group A) was 639.72 mm³. Mean volume of the notch in the failure cases (group B) was 2158.11 mm³. Glenoid cavity classes in group A were 17 normal, 20 abrasion, 8 fracture, 0 amputation. In group B the classes were 2 normal, 9 abrasion, 2 fracture, 2 amputation. The volume of the notch was significantly correlated with outcome (Spierman test). There was no significant correlation for the glenoid cavity.

Discussion: Despite the absence of a significant correlation with the glenoid cavity classes, the presence of a glenoid lesions in cases with a bony notch smaller than 500 mm³ had an important impact in three out of the four failures (two amputations and one fracture). Considering a threshold value of 1000 mm³, the rate of failure was 7.7% irrespective of the glenoid lesions and 52.5% if glenoid amputations and fractures were excluded.

Conclusion: It would appear that arthroscopic treatment should be reserved for patients with a small humeral notch (< 1000 mm³). Glenoid lesions should also be quantified in patients with small notches.